Neutrophil Gelatinase-Associated Lipocalin (NGAL) concentration in urine is superior to CA19-9 and Ca 125 in differentiation of pancreatic mass: Preliminary report
Affiliations: [a] Department of General and Transplant Surgery, Medical University of Lodz, Lodz, Poland | [b] Department of Pulmonology and Allergy, Medical University of Lodz, Lodz, Poland | [c] Department of Anesthesiology and Intensive Care, Medical University of Lodz, Lodz, Poland
Correspondence:
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Corresponding author: Piotr Hogendorf, Department of General and Transplant Surgery, Medical University of Lodz, 22 Kopcinskiego St. 90-153, Lodz, Poland. E-mail:[email protected]
Abstract: BACKGROUND: Currently pancreatic cancer is the fourth leading cause of cancer-related
death worldwide. Because of its late manifestation and consequent dismal
prognosis, there is an urgent need to develop highly sensitive and specific
marker. Neutrophil Gelatinase-Associated Lipocalin (NGAL) recently emerged
as a protein playing an important role in carcinogenesis of various
neoplasms. OBJECTIVE: Our aim was to assess the potential of urine and bile concentration of NGAL
in differentiating pancreatic adenocarcinoma from chronic pancreatitis. METHODS: Forty-two patients operated on due to pancreatobiliary lesions were enrolled in
this study. All enrolled patients had eGFR within reference range. Levels of
CEA, CA 125 and Ca19-9 were assessed using standard laboratory protocols. A
sample of urine was collected prior to the surgery. Intraoperatively a 5 ml
sample of bile was collected directly from the common bile duct. Bile and
urine levels of NGAL were measured using a ELISA kit. After standard
pathological examination of specimens obtained during surgery, patients were
divided into 2 groups: 21 patients with pancreatic adenocarcinoma and 15
patients with focal chronic pancreatitis. RESULTS: NGAL concentration in bile in patients with PDAC vs CP was 75.72 ± 16.05
ng/mL vs 62.62 ± 18.6 ng/mL respectively (p= 0,011). NGAL concentration in
urine was 43.26 ± 21.21 ng/mL vs 17.96 ± 14.58 ng/mL (p= 0.002)
respectively. In order to compare these markers with routinely used ones,
ROC curve was built for Ca125 to establish cutoff point and in case of
CA19-9 clinically used cutoff (≥ 37U/mL) was applied. Sensitivity and
specificity for NGALurine with cutoff value of 27 ng/mL was 80.95%
and 80% respectively, while these values for NGALbile were
71.43% and 80% respectively. Ca19-9 measured in plasma with clinically
used cutoff value had sensitivity of 71.43% and specificity of 73.33%.
Sensitivity and specificity for Ca 125 measured in plasma with cutoff
value of 13 U/mL were 85.71% and 66.67% respectively. CONCLUSIONS: In conclusion, NGAL in urine and bile are remarkably accurate in
differentiating pancreatic mass due to chronic pancreatitis from pancreatic
adenocarcinoma. Therefore, NGAL concentrations in bile and urine should be
further investigated in order to assess their usefulness in early pancreatic
adenocarcinoma diagnosis.
